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Submitted by Dr. Michael Duenas on
Dear Dr. Michael Engelgau, It is wonderful to see this great work. I fully support the argument that the epidemiologic transition of non-communicable diseases (NCDs) could be blunted and even dramatically reduced by through improving primary care for NCDs. The strength of this association is reliant on early intervention and access to a full range of essential primary care. One area of essential primary care type of treatment that is cost effective, of high value and directly tied to NCDs, but often overlooked, is comprehensive primary vision health/optometry services. The importance of this essential comprehensive service is based on the diseases have important eye findings that can be detected during a comprehensive eye examination, thereby providing unique treatment and coordinating potentials, at the various life stages, (A) Infants and Toddlers ;( B) Children; (C) Adolescents ;( D) Young Adults; (E) Older Adults and Seniors, as indicated below. NCDs tied to eye care / Most to Least Common: (ICD-9-CM Codes) 1. Diabetes (250-259) (Type 1, Type 2) 2. Hypertension (401) LS/ C,D,E 3. Arteriolosclerosis/Hardening of the Arteries (440.9) LS/D,E 4. Vessel Occlusive Diseases (430-438) (440) LS/D,E 5. Raised Intracranial Pressure LS/ A,B,C,D,E 6. Sjögren’s Syndrome (710.2) LS/D,E 7. Migraine (346) LS/B,C,D,E 8. Thyroid Dysfunction (242.0) LS/ C,D,E 9. Hyperviscosity Blood Syndromes 10. Rheumatoid Arthritis (714) LS/ D/E 11. Dermatitis Atopic (691) LS/A,B,C,D,E 12. Acne Rosacea (695.3) LS D,E 13. Pre-Diabetes/ IFG/ IGT) LS/ B,C,D,E 14. Psoriatic Arthritis (716.9) LS/D,E 15. Gout (274.8) LS/E 16. Sinusitis Chronic (473.0) LS/C,D,E 17. Pituitary Tumors (194.3) LS/C,D,E 18. Sarcoidosis (135.0) LS/D,E 19. Ankylosing Spondylitis (720) LS/ D,E 20. Juvenile Rheumatoid Arthritis LS/B,C,D,E 21. Meningitis (320) (321) LS/ A,B,C,D,E 22. Systemic Lupus ( 710.0) LS/D,E 23. Scleroderma (710.1) LS/D,E 24. Reiter’s Syndrome (099.3) LS/E 25. Sturge-Weber Syndrome (759.6) LS/A,B,C,D,E 26. Neurofibromatosis LS/A,B,C,D,E 27. Myasthenia Gravis (358.00) LS/C,D,E 28. Marfans Syndrome (090.49) LS/A,B,C,D,E 29. Down’s Syndrome (758) LS/A,B,C 30. Behcet’s Disease (136.1) LS/D,E 31. Usher’s Syndrome LS/ A,B,C,D,E 32. Crohn’s Disease (555.9) LS/ D,E 33. Pseudoxanthoma Elasticum LS/ D,E 34. Stevens-Johnson Syndrome (695.1) LS/C,D,E 35. Albinism (270.2) LS/A,B,C,D,E 36. Anemias (280-289) LS/ A,B,C,D,E 37. Nerve Diseases and Palsies (350-359) (Third, Fourth, Sixth, Seventh) LS/ D,E 38. Leukaemias (200-208) LS/A,B,C,D,E 39. Other Cancers ( 190.0) (216.1) (224.0) LS/A,B,C,D,E 40. Vitamin A Deficiency (268) LS/ B,C,D,E 41. Multiple Sclerosis (340) LS/ C,D,E Thus, in describing the challenge of how best to juggle this “double burden”, access to a comprehensive eye examination may provide earlier detection, timelier treatments and reduced disabilities and deaths associated with a number of NCDs that disproportionately burden these vulnerable South Asia populations. Additionally, enhanced disease prevention opportunities exist beyond NCDs based on eye findings linked to certain behaviors. As an example, cigarette smoking, use of other tobacco products, engaging in unprotected sex, the excessive use of alcohol, IV drug use, excess UV exposure, repeated use of certain drugs or drug combinations, all have specific eye findings that would provide additional opportunities for patient education ,council and access to treatment. Hopefully this understanding can aid countries in finding the optimum ballance for the healthof thier populations. Respectfully, Michael R. Duenas, O.D. Chief Public Health Officer, American Optometric Association mrduenas@aoa.org